Silver Registration

"*" indicates required fields

CLASS COORDINATORS: KATHY NOONAN AND MIKE NORTHCUTT – 314-239-6126

ENTRANCE TO THE GYM WHERE CLASSES ARE HELD AT 300 N. NEW BALLAS ROAD IS IN THE REAR OF THE BUILDING.

Membership Year*

Class Session 6*

Is anyone in your household a member for the current year?*

Dance Classes

Choose any classes that you would like to register for:

Member Classes–Session 6*

Tuesday 7-8 pm – American Silver – Argentine Waltz & Cha cha

Tuesday 8-9 pm – International Silver – Quickstep & Rumba

Member

Non-Member Classes–Session 6*

Tuesday 7-8 pm – American Silver – Argentine Waltz & Cha cha

Tuesday 8-9 pm – International Silver – Quickstep & Rumba

Non

Dancer Information

Dancer Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone*

Mobile

Choose Your Skill Level*

YOU MUST PROVIDE YOUR OWN PARTNER FOR THE TUESDAY CLASSES.

First and Last name used to register your dance partner. **

First Last

*NOTE: Each Dancer still must be registered independently

Payment Information

Your Total

Choose Payment Method

Online (PayPal or Credit Card)

Mail In Check

If paying by credit card or check, you do not need to fill out the PayPal information. Continue scrolling down, past the ‘Pay with PayPal’ and ‘Log In’ button. At the bottom is the button ‘Pay with Debit or Credit Card’. Click on ‘Pay with Debit or Credit Card’. This will bring you to a page to fill out your credit or debit card information.

Please submit this form and mail your check:
Payable to: St. Louis Ballroom Dancers

Mail to:
Kathy Noonan, 907 Lisa Lane, St. Louis, MO 63122